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Wednesday, August 12, 2009

Negative flexibility

I was talking to a colleague today who had two kids of school age. She explained to me that on days when it would snow, she was told to call the school at noon to find out if they would be closing early for the day. If they were, the kids would have to be picked up.

"Oh my god!" I said. "What do you do if the school closes??"

"Panic!" she replied.

When I finished residency, the most important thing to me was finding a job that would be flexible. My residency was not that flexible... in fact, I joked that my job had "negative flexibility." I invented this term to refer to situation that came up repeatedly when I was pregnant:

On the inpatient rehab unit, we admitted patients every day from Monday to Friday. It was impossible to know at the start of the day if there would be an admission coming that day. When I had my OB appointments (first monthly, then bimonthly, then weekly), I tried very carefully to schedule them in such a way that nobody would get stuck with my work. I chose the last appointment of the day (4:15) and did my best to get all my work done before it was time to leave. I let everyone know well in advance that I needed to leave a bit early.

Then, almost like clockwork, at 3PM, I'd find out there was an admission coming in an hour. Despite all my planning, I'd be stuck with the dilemma of trying to reschedule my appointment (again) or beg another resident to cover. Some residents were quite nice about covering ("anything for the mama!"), but others held it against me for the next three years ("and what exactly will you do for me?"). Luckily, once my daughter and I became two separate entities, my husband was able to deal with some of the doctor's appointments by himself.

I think very few residencies provide any flexibility. My own father deals with residents and fellows, and he says that he gets very upset when one of them asks to leave early for something child-related. "Don't you have a spouse who can do it?" he asks them.

So when residency ended, I was looking for positive flexibility. I didn't care as much about the job's hours so much as the flexibility to stay home for a morning or even *gasp* a whole day if I was sick or the daycare got snowed in. As a doctor, this is not so easy. You have to think long and hard before canceling a whole clinic or calling a colleague to cover.

Then again, how much flexibility does any job have? If I were a teacher, I couldn't just abandon my students at noon and rush home. If I were a lawyer, I'd have deadlines and hearings (or whatever lawyers do).

However, I would like to think I have found a job with a modicum of flexibility. But ask me again in six months.

15 comments:

i am a working mom in medicine with kids. i totally sympathize with your struggles, having been in the exact same positions my self. but, as an attending now, the buck definitely stops with me. if a fellow/resident needs to leave early, it means I stay late, and miss dinner or bedtime or doctor's appts with my kids. I know this is not what you meant, but i think it is important to point out for readers that it is NOT (or rarely) the case that there is someone with free time who is holding out on people in your situation or who is just being difficult. these are hard situations. my husband and I go out of our way not to have patients scheduled on the same day - and I would often go back to the hospital after OB appts when I was pregnant.

I just gave up my job in advertising for the "negative flexibility" there. I don't know how many jobs there are with the amount of flexibility that most moms need...crossing my fingers for you that you have found one!

Sometimes I wonder about how we spend the entire day caring for patients- and at times fall short when it comes to taking care of each other (our colleagues). As MiM we have SERIOUS pressure to find flexibility. If/ when we do create such an environment I believe everyone benefits. Good luck Fizzy.

To Anon: didn't mean to imply I thought any attendings were holding out on me. I feel just as if not more guilty asking an attending to cover. The big difference is that as an attending, at least on our service, you have more flexibility about time. As a resident, you have to do things at the attending's convenience. It would have been impossible for me to come back later and do the admit, since the attending would then be stuck at the hospital much later too.

I had all my children post-residency, but I remember several women became pregnant while in residency (especially on the peds side) and would have to regularly ask someone to cover in the types of situations you mentioned, Fizzy. I feel like they rarely got any hassle for this, but maybe it's b/c they would generally ask the other women residents (even on the IM side, we would try to be helpful). I find it very sad to hear about such negative attitudes towards helping your colleagues out. Even now as a private physician, I have gravitated towards practices who have physicians who also have young children or have had young children. It seems that there has always been a sense of helping each other out in tough situations such as what you describe (especially when you do NOT have a spouse who can cover for you).

Mommy Doc: I didn't mean to diss on my fellow residents either because most of them were nothing short of awesome. I think part of it was my guiltiness for making others cover so I perceived that everyone was angry. Also, there WAS one resident I worked with closely who had this insane sense of fairness and felt that since I never covered for HIS ob appts, he shouldn't have to cover mine. His answer to my asking for coverage was always an immediate, "What will you do for me?" I could write a whole other post about this guy.

If you ever decide to leave medicine and work in the private sector in a related field, ask me where my husband works. They are awesome to parents who need to take maternity leave, who want to go part time, who want to resume working full time. They understand when people need to leave or take a day for child related reasons. They have on-site daycare.

Ok, they are in the private sector and job security is lousy. I just hope when my husband and I decide to have kids that he will take advantage of their flexibility. Because as a resident, I know *I* won't be able to.

Clinical medicine rarely is a 9-5 job. And similar to "Anonymous" I have been in tough situations when my children were young. It helps if the children arrive post-residency, when there is a little more flexibility. But from the position of the senior attending in my group, I now see the other side. I try to be sensitive to young mothers, and have hired two in my private practice, with the understanding that they will be flexible enough to cover each other when one has to be out. It has worked out very well in general, but guess what - this week, of a 4 physician practice, I'm "home alone". Said people failed to coordinate their vacations, and I'm left with all the urgent, can't wait appointments for the panel of 4 physicians! So when you ask for flexibility, know that it works both ways.

Things come up. Different doctors limit how much their real life and professional lives intermingle. I wouldn't hesitate to admit a patient for a fellow resident who needs to go to a doctor's appt or something with their child as long as it were rare. My hubby works in a job where he is extremely flexible.

I don't think having children "arrive post-residency" is the cure all. Pregnancy poses a problem in medicine for whoever you are working with at that time... for your partners or your co-residents. With plenty of non-trads entering medicine a little late, it also seems understandable why there might be more babies being born to mothers in residency than in the past. The 80 hour work rules make it more doable also. Yes, it causes headaches for residency directors (or their secretaries - who do the scheduling) everywhere, but I don't think my schedule will truly be easier post-residency. And I suspect that goes for many in internal medicine and surgery.

In my program, there are plenty of understanding guys. There are some ladies who give real grief - those who decided to delay (sometimes permanently) the decision to have children so they could pursue their career. The blokes - especially those with kids - stare in amazement.

How much flexibility? I think it depends on the office/departmental/institutional culture as well as on the individuals you work with. The first you may be able to gauge while interviewing or early on in the job. The latter takes time - 6 months to a year.

Supportive environments do exist, however. I'm an academic hospitalist who following 9 months of fairly intense infertility evaluations and treatment is seven and a half months pregnant with our first child. Our great schedule has allowed me to get by without needing to ask for coverage. My infertility and OB appointments were/are within walking distance of the wards where my patients are and were/are easily fitted into my rounding schedule. I will admit that having your colleagues as your physicians may make things a little easier. I do have a great section chief who was very accommodating with the schedule once he learnt I was pregnant.

I am very grateful for my position and take none of this for granted. During my year as chief resident, just prior to taking this job, 9 out of 30 residents I was directly responsible for either were expecting or their wives were. Half of these were in the graduating class. One had a wife who was expecting twins, didn't drive and was on minimal activity and another wound up being put on bed rest at 29 weeks. It took a lot of schedule gymnastics to maintain a functional program! Having been on the other end I better appreciate the challenges those in charge may face but feel that they are not insurmountable given the right attitude and some "out of the box" thinking.

Mothers in Medicine is a group blog by physician-mothers, writing about the unique challenges and joys of tending to two distinct patient populations, both of whom can be quite demanding. We are on call every. single. day.

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